<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/Tr</xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
        <title>MEGA 2.0</title>
        <meta http-equiv="X-UA-Compatible" content="IE=Edge" />
        <link rel="stylesheet" type="text/css" href="../css/style.css" />
        <script type="text/javascript" src="../js/jquery-2.1.1.js"></script>
		<script type="text/javascript" src="../js/jquery.jscrollpane.js"></script>
		<script type="text/javascript" src="../js/jquery.mousewheel.js"></script>
		<script type="text/javascript">
        $(document).ready(function() {  

			$('.fm-account-select select').unbind('change');
			$('.fm-account-select select').bind('change', function(e)
			{
				var val = $(this).find(':selected').text();
				$(this).parent().find('.account-select-txt').text(val);
			});
			  
		});
        
        </script>
        
    </head>

    <body id="bodyel" class="bottom-pages">

        <div class="fm-dialog-overlay payment-dialog-overlay"></div>

        <div class="fm-dialog payment-dialog">
                <div class="btn-close-dialog"></div>
                
                <div class="payment-dialog-body">
                   <div class="plan-icon pro1" ><div class="reg-st3-membership-icon"></div></div>
                   <div class="payment-plan-info">
                      <div class="payment-plan-title">PRO I</div>
                      <div class="payment-plan-txt">1 month <span>(non-recurring)</span></div>
                   </div>
                   <div class="payment-plan-price">9.99€</div>
                   <div class="clear"></div>
                   
                   <div class="payment-half-block first">
                        
                        <div class="payment-form-title">
                        	Enter your billing details:
                        </div>
                        <div class="fm-account-input">
                        	<input type="text" value="" placeholder="Address 1" >
                        </div>
                        <div class="fm-account-input">
                        	<input type="text" value="" placeholder="Address 2" >
                        </div>
                        <div class="fm-account-input">
                        	<input type="text" value="" placeholder="City" >
                        </div>
                        <div class="fm-account-input">
                        	<input type="text" value="" placeholder="Province" >
                        </div>
                        <div class="fm-account-select">
                        <span class="account-select-txt">Country</span>
                            <select>
                                <option value="nz">Newe Zealand</option>
                                <option value="rb">Belarus</option>
                            </select>
                        </div>
                        <div class="fm-account-input code">
                                <input type="text" value="" placeholder="Postal Code" >
                        </div>
                        <div class="clear"></div>
                   
                   </div>
                   
                   <div class="payment-half-block second">
                    	
                        <div class="payment-form-title">
                        	Enter your payment details:
                        </div>
                        <div class="payment-cc">
                            <div class="radioOn hidden" id="rad1_div">
                            	<input type="radio" id="rad1" class="radioOn" value="1" checked="checked">
                            </div>
                            <div class="payment-cc-icon visa"></div>
                            <div class="payment-cc-icon mastercard"></div>
                        </div>
                        <div class="payment-short-bl first">
                            <div class="fm-account-input">
                            	<input type="text" value="" placeholder="First Name" >
                            </div>
                        </div>
                        <div class="payment-short-bl second">
                        	<div class="fm-account-input">
                        		<input type="text" value="" placeholder="Last Name" >
                        	</div>
                        </div>
                        <div class="clear"></div>
                        <div class="fm-account-input">
                        	<input type="text" value="" placeholder="Credit Card Number" >
                        </div>
                        <div class="payment-short-bl triplex first">
                        	<div class="fm-account-select">
                        		<span class="account-select-txt">Month</span>
                                <select>
                                    <option value="october">Oct.</option>
                                    <option value="november">Nov.</option>
                                </select>
                        	</div>
                        </div>
                        <div class="payment-short-bl triplex second">
                        	<div class="fm-account-select">
                        		<span class="account-select-txt">Year</span>
                        		<select>
                        			<option value="2014">2014</option>
                        			<option value="2014">2015</option>
                        		</select>
                        	</div>
                        </div>
                        <div class="payment-short-bl triplex third">
                        	<div class="fm-account-input">
                        		<input type="text" value="" placeholder="CCV" >
                       		</div>
                        </div>
                        <div class="clear"></div>
                        
                        <div class="payment-buy-now">
                        	Buy Now
                        </div>
                   
                   </div>
                   <div class="clear"></div>
   
                </div>
                
        </div>

    </body>
</html>
